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Referrals + transfers (internal/external)

Purpose

Provide a consistent process when:

  • a client is not a fit,
  • a client needs a different clinician,
  • a client needs external services.

Head & Heart default (continuity inside the practice)

Head & Heart clients stay at Head & Heart unless an outside referral is indicated for client need or clear clinical/ethical reasons below.

That usually means:

  • Stay or transfer internally first: If fit, modality, or scheduling is the issue, use an internal transfer to another Head & Heart clinician when someone on the team is a better match (process below).
  • Unfamiliar population or issue type alone is not a reason to decline or externally refer: consider growth, supervision, and honest competence—stay or transfer internally when another Head & Heart clinician is a better match; go external only when client need or scope truly requires it (see sections below).
  • Refer externally when one or more of these apply:
    • Head & Heart does not offer the treatment, modality, or service the client needs (and it is not reasonable to meet that need internally).
    • Therapist–client fit is not appropriate and there is no other Head & Heart therapist who would be a clearly better fit.
    • Language or culture requires a provider or context we cannot adequately provide within the team.
    • A higher level of care or specialized external service is needed (e.g. crisis services, intensive programs, specific assessments) that are not available internally.
    • The client, with informed choice, requests an external referral (document the discussion).

Do not refer a Head & Heart client to another clinic, agency, or practice where you also work (including other locations or your own private practice) so that care continues with you outside Head & Heart. That undermines the shared practice model and creates a conflict of interest. If care must continue outside Head & Heart, the external provider must be unrelated to your other employment—and you should follow the External referrals process below and admin notification norms as usual.

If you are unsure whether to stay internal vs refer out, consult Katherine and/or admin before committing the client to a path.

Internal transfers (Head & Heart)

If you are referring a client to another counsellor within Head & Heart, please follow this internal transfer process.

When to consider:

  • the client requests a different clinician
  • scope-of-practice mismatch or a better-fit modality/population match within the team
  • scheduling/availability constraints mean you cannot provide appropriate continuity of care
  • boundary/conflict-of-interest concerns indicate a transfer is the safest option
  • therapeutic rupture where transfer is clinically appropriate and client-centered

Process:

  1. Discuss fit with the client (supportive, non-shaming).
  2. Contact the internal therapist you wish to refer to and CC Katherine on the email.
  3. If the receiving counsellor agrees to take the client, please document the transfer and any relevant consents (including whether the client is consenting to have their file transferred).
  4. Obtain a Release of Information (ROI) from the client to transfer the file to the receiving counsellor, and CC admin that this has been completed.

External referrals

Use an external referral only when an internal transfer cannot meet the client’s needs, per the Head & Heart default section above.

When to consider (summary):

  • the client’s needs are outside team scope and there is no appropriate internal match
  • therapist–client fit is not appropriate and no Head & Heart clinician is a better fit
  • language, culture, modality, or specialization requires a provider we do not have internally
  • a higher level of care or specialized external service is required
  • the client requests an external referral (informed choice)

Process:

  1. Clarify what the client is seeking.
  2. Provide appropriate options within scope and competence.
  3. Document what was provided.

Please also note:

  • If the client is not a good fit for you or is outside of your scope of practice, and in your opinion there is no therapist on our team whose scope of practice would serve the client, please notify admin of the external transfer.
  • If you are referring to an external source, the client may request to have their notes transferred or request that you have a conversation with their new therapist. Please obtain a signed Release of Information (ROI) from the client before transferring notes or speaking with the new therapist.

Important note

  • Do not share client information without appropriate consent.